Neurobiological and psychosocial risk for transition from acute to chronic musculoskeletal pain in adolescence

青春期从急性肌肉骨骼疼痛转变为慢性肌肉骨骼疼痛的神经生物学和心理社会风险

• 批准号: 10677763
• 负责人: Bonnie J Nagel
• 金额: $ 66.79万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10677763
• 关键词: Acute; Acute Pain; Address; Adolescence; Adolescent; Adult; Age; Ankle; Back; Biological Factors; Brain; Characteristics; Childhood; Cognition; Complex; Data; Development; Disease remission; Emotional; Environmental Risk Factor; Female; Functional Magnetic Resonance Imaging; Goals; Growth; Health Care Costs; Heterogeneity; Incidence; Individual; Intervention; Knee; Learning; Lower Extremity; Magnetic Resonance Imaging; Maintenance; Measures; Medial; Mental Health; Modeling; Moods; Musculoskeletal; Musculoskeletal Pain; National Institute of Arthritis, and Musculoskeletal, and Skin Diseases; Neurobiology; Nucleus Accumbens; Pain; Pain Free; Pain Measurement; Parents; Participant; Pathway interactions; Persistent pain; Phenotype; Physicians; Population; Prefrontal Cortex; Process; Proxy; Psychological Factors; Public Health; Quality of life; Recording of previous events; Regulation; Remittance; Reporting; Research; Rest; Risk; Risk Assessment; Risk Factors; Risk Reduction; Sampling; Strategic Planning; Structure; Subgroup; Symptoms; Syndrome; Thick; Time; United States National Institutes of Health; Vertebral column; Visit; Youth; age related; biopsychosocial; chronic musculoskeletal pain; chronic pain; cost; critical period; disability; early adolescence; emotional stimulus; executive function; experience; foot; gray matter; mind control; multimodal neuroimaging; multimodality; neural; neural circuit; neuroimaging; novel; novel therapeutic intervention; pain catastrophizing; pain chronification; pain processing; pain symptom; physical conditioning; prevent; preventive intervention; programs; prospective; protective factors; psychosocial; recruit; response; sex; societal costs; structural imaging; therapy design; time use

Project Summary Chronic musculoskeletal (MSK) pain problems increase dramatically in the adolescent years, with wide impact and high direct and indirect healthcare costs. Unfortunately, adolescents with chronic MSK pain are likely to become adults with chronic MSK pain, and also suffer from high levels of negative consequences, including disability, poor quality of life, and poor psychosocial functioning. In the adolescent developmental period, acute MSK pain complaints (most commonly spine, knee, and foot or ankle pain) account for a large portion of physician visits, and recent studies estimate that about 30-35% of these youth transition from acute pain to a chronic pain state. However, mechanisms underlying the transition from acute to chronic pain states are poorly understood, particularly in adolescents. While there are a number of known biopsychosocial risk factors for the development of chronic pain, better mechanistic understanding of transition between acute and chronic pain states is crucial for the development of novel therapeutics and preventative interventions designed to stop chronic pain before it becomes disabling and costly. The proposed study will examine both key neurobiological and biopsychosocial risk factors that contribute to the development of chronic MSK pain in adolescents. To our knowledge, this would be the first neuroimaging study conducted in a sample of youth presenting for treatment for acute MSK pain. Capturing treatment-seeking adolescents with MSK pain and following these youth over the course of the following year, will provide novel information about candidate mechanisms and risk for the transition from acute to chronic pain states. Using resting state and task-based functional and structural magnetic resonance imaging, alongside comprehensive self and proxy report measures of biopsychosocial history and function, we will identify independent multimodal neurobiological components associated with acute MSK pain and examine associations with theoretically-grounded biopsychosocial risk pathways for chronic pain in the context of a host of environmental factors. We will then prospectively examine how these neurobiological and biopsychosocial risk pathways (pain processing, mood, and pain related cognition) are related to pain persistence and pain-related impact over time using parallel process latent growth curve modeling, as well as retrospectively identify additional state) neurobiological phenotypes (beyond those associated with the acute MSK pain that differentiate individuals demonstrating pain persistence from those with symptom remission. Participants will include adolescents, ages 11-17, with n=200 acute MSK pain and a sample of n=80 age- and sex-matched pain-free controls, as well as a participating parent. These adolescents will be followed an additional three times (every 3 months over a 1 year period) to examine pain persistence and pain-related impacts over time. Determining mechanisms and moderators of risk during this developmental transition will provide critical information for interventions aimed at reducing risk for chronic pain in youth.

项目概要 慢性肌肉骨骼 (MSK) 疼痛问题在青少年时期急剧增加，影响广泛 以及高昂的直接和间接医疗费用。不幸的是，患有慢性 MSK 疼痛的青少年可能会 成年后患有慢性 MSK 疼痛，并且还会遭受严重的负面后果，包括 残疾、生活质量差和心理社会功能差。在青少年发育时期，急性 MSK 斯隆疼痛投诉（最常见的是脊柱、膝盖、足部或脚踝疼痛）占大部分 医生就诊，最近的研究估计，这些青少年中约有 30-35% 从急性疼痛转变为疼痛 慢性疼痛状态。然而，从急性疼痛状态转变为慢性疼痛状态的机制尚不明确。 理解，尤其是青少年。虽然有许多已知的生物心理社会风险因素 慢性疼痛的发展，更好地理解急性和慢性疼痛之间的转变机制 国家对于开发旨在阻止新疗法和预防性干预措施至关重要 慢性疼痛在其变得致残且代价高昂之前。拟议的研究将检查两个关键的神经生物学 以及导致青少年慢性 MSK 疼痛发展的生物心理社会风险因素。致我们的 据了解，这将是第一个针对接受治疗的青少年样本进行的神经影像学研究 用于急性 MSK 疼痛。捕捉患有 MSK 斯隆疼痛的寻求治疗的青少年并跟踪这些青少年 明年的课程，将提供有关候选机制和过渡风险的新信息 从急性到慢性疼痛状态。使用静息状态和基于任务的功能和结构磁力 共振成像，以及生物心理社会史和综合自我和代理报告测量 功能，我们将确定与急性 MSK 疼痛相关的独立多模式神经生物学成分 并检查慢性疼痛与有理论依据的生物心理社会风险路径的关联 一系列环境因素的背景下。然后我们将前瞻性地研究这些神经生物学和 生物心理社会风险途径（疼痛处理、情绪和疼痛相关认知）与疼痛相关 使用并行过程潜在生长曲线建模，随着时间的推移，持久性和疼痛相关的影响，以及 回顾性地确定额外的 状态） 神经生物学表型（除了与急性 MSK 疼痛相关的表型） 区分表现出持续疼痛的个体和症状缓解的个体。 参与者将包括 11-17 岁的青少年，n=200 名患有急性 MSK 疼痛的人，样本 n=80 名年龄和年龄 性别匹配的无痛对照，以及参与的父母。这些青少年将被跟踪 另外 3 次（一年内每 3 个月）检查疼痛持续性和疼痛相关性 随着时间的推移产生的影响。确定这一发展转型期间风险的机制和调节因素将 为旨在降低青少年慢性疼痛风险的干预措施提供关键信息。